Individual
MR. CHARLES THOMAS TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 COLONIAL WAY STE 2, JESUP, GA 31545-0132
(912) 588-1919
(912) 588-1919
Mailing address
208 SCRANTON CONNECTOR, SUITE 117, BRUNSWICK, GA 31525-0559
(912) 264-5961
(912) 262-9499
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
026402
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000291079A
—
GA
01
—
01035667
AMERIGROUP
GA
01
—
390004393
RAILROAD MEDICARE
GA
01
—
616370
BLUE SHIELD
GA
01
—
N363398
WELLCARE
GA
Enumeration date
08/21/2006
Last updated
01/16/2020
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